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Wednesday, September 25, 2013

Prenatal Exposure to AEDs Is Associated with Impaired Motor Skills

Thanks in large part to population-based pregnancy registries, new data on risk of fetal exposure to antiepileptic drugs (AEDs) continue to emerge. The most recent finding, published online in the Sept. 23 JAMA Neurology, by Gyri Veiby, MD, and colleagues, reports that prenatal exposure to AEDs is associated with impaired motor skills in children.The study drew on detailed informationfrom theNorwegian Mother and Child Cohort Study, comprising mothers at 13 to 17 weeks of pregnancy who were recruited from 1999 to 2009. The mothers reported on their child’s motor and social skills, language, and behavior at 6 months (n = 78, 744), 18 months (n = 61, 351), and 36 months (n = 44, 147) of age. Participants also provided detailed information on breastfeeding during the first year. The majority of mothers were receiving monotherapy (n = 182), which most commonly consisted of lamotrigine (n = 71), carbamazepine (n = 48), and valproate (n = 27).Dr. Veiby and colleagues analyzed the motor and social skills of 503 children at six months of age, in 490 pregnancies by 441 women with epilepsy. They found that the 223 infants who had been exposed to AEDs in utero had a higher risk of impaired fine motor skills at 6 months of age when compared with the unexposed reference group (11.5 % vs 4.8%). Those children who were exposed to multiple AEDs had significantly higher risks of impairment in both fine motor (25% vs 4.8%) and social skills (22.5% vs 10.2%), the authors found.

The investigators also found that breastfeeding did not contribute to adverse effects in children from 6 months of age to 36 months; rather, “there was a trend toward a more favorable outcome in children who were continuously breastfed, especially for early autistic traits.” Still, regardless of breastfeeding, the AED-exposed group of children had more autistic traits at 36 months.

“Prenatal exposure to antiepileptic drugs was associated with impaired fine motor skills already at age 6 months, especially when the child was exposed to multiple drugs,” Dr. Veiby and colleagues concluded. They added that mothers with epilepsy should be encouraged to breastfeed, regardless of antiepileptic drug treatment.